Questionnaire
Designing, Implementation and Evaluation of PRECEDE PROCEED Model-based Intervention on Oral and Dental Health
among Primary Schools’ Students of Rafsanjan City
Knowledge
What is the function of teeth?
1- Chewing food Yes, no, I do not know 2- Speech Yes, no, I do not know
3- Maintain facial beauty Yes, no, I do not know What are the effective factors in causing caries?
4- Sugary substances Yes, no, I do not know 5- Microbes Yes, no, I do not know
6- The strength or material of the teeth Yes, no, I do not know 7- How long the food stays in the teeth Yes, no, I do not know How can we tell if our teeth are decaying?
8- The presence of brown and black spots on the teeth and perforation of the teeth Yes, no, I do not know
9- Sensitivity of teeth to heat and cold Yes, no, I do not know
10- Bleeding from the gums when brushing or toothache Yes, no, I do not know What is the complication of tooth decay?
11- Psychological problems such as embarrassment Yes, no, I do not know 12- Physical problems such as halitosis Yes, no, I do not know
13- When should oral hygiene behavior begin?
A: Before the teeth grow
B: From 6 months at the same time as the first tooth in the mouth A: Since all the teeth came in
D: I do not know
14- What is the most important way to remove teeth plaque?
A: Brushing regularly and correctly B: Washing only with water
C: remove Plaque by a dentist D: I do not know
15- What is the minimum time for your brushing?
A: 2 minutes B: 3 minutes C: 4 minutes D: I do not know
16- When brushing, how much toothpaste do we need to put on the toothbrush?
A: the size of a pea
B: the size of a half toothbrush C: As long as the toothbrush D: I do not know
17- How often should we change our toothbrush?
A: Every 2-3 months B: Every 3-4 months C: Every 6 months D: I do not know
18- How should we brush the External surfaces of upper teeth?
A: By moving the toothbrush back and forth B: From top to bottom
C: From bottom to top D: I do not know
19- How many times a day should we brush our teeth?
A: Once B: Twice
C: Three times and more D: I do not know
20- When is it better to brush?
A: Only after eating lunch B: Only after eating dinner
C: After eating breakfast, lunch and dinner and eating sweets and snacks
D: I do not know
21- How often should children use fluoridated mouthwash?
A: Once a week B: Once a month C: Twice a week D: I do not know
22- To examine their teeth, how often should refer to the dentist?
A: Once every three months B: Once every 6 months
C: Whenever a tooth is damaged D: I do not know
23- What is the best way to clean between teeth?
A: Brushing well B: Using dental floss C: Using mouthwash D: I do not know
24- How many times a day should we floss, at least?
A: Once B: Twice C: Three
D: I do not know
Attitude A: I agree B: I have no opinion C: I disagree 1- I think brushing is good.
2- I feel good after brushing.
3- Brushing is very useful for dental health.
4- There is no special method of brushing, it is good to brush anyway.
5- Brushing once a day is enough.
6- After consuming sugars and sweets, it is necessary to brush immediately.
7- Toothpaste has no effect on oral health.
Perceived susceptibility A: I agree B: I have no opinion C: I disagree
1- If I do not brush my teeth, my teeth may decay.
2- The resistance of my teeth is good and they never decay.
3- My teeth stay healthy until old age.
Perceived severity A: I agree B: I have no opinion C: I disagree 1- Tooth decay is a serious disease.
2- If my teeth rot, I will have severe toothache.
3- If my teeth rot, my mouth smells bad.
4- If my teeth rot, I will look ugly.
5. If my teeth rot, I cannot speak well.
6- If my teeth rot, I may lose my friends.
7- If my teeth rot, my family will be upset with me.
8- If my teeth rot, the school health teacher will be very upset with me.
9- If my teeth rot, my homework and daily tasks will be delayed.
10- If my teeth rot, my family will have to spend a lot of money on me.
Perceived benefits A: I agree B: I have no opinion C: I disagree 1- Brushing prevents tooth decay.
2- Brushing causes vitality and freshness.
3- Brushing increases my self-confidence.
4- Brushing makes me have beautiful teeth.
5- Brushing makes my teeth decay later.
6- Brushing makes my teeth whiter.
7- Brushing makes my mouth fragrant.
8- Brushing makes my family love me more.
9- Brushing makes me make more friends.
10- Brushing makes my teacher like me more.
11- Brushing makes my school health instructor encourage me.
Perceived barriers A: I agree B: I have no opinion C: I disagree 1- I do not have enough time to brush my teeth after eating breakfast.
2- I do not have mood to brush my teeth after eating dinner.
3- I do not brush because I do not have a toothbrush and toothpaste.
4- I do not brush because I do not know the correct way to brush.
5- Brushing give me nausea, that's why I don't brush.
6- When I brush my teeth, blood comes out of my gums, that's why I don't brush.
Subjective norms A: I agree B: I have no opinion C: I disagree 1- My family believes that I should brush my teeth regularly.
2- According to my friends, we should brush regularly.
3- The school health teacher believes that we should brush our teeth regularly.
Motivation to comply A: I agree B: I have no opinion C: I disagree 1- Family opinion is important for me to brush my teeth.
2- The opinion of my friends is important for me to brush my teeth.
3- The opinion of my school health teacher is important for me to brush my teeth.
Perceived self-efficacy A: Yes B: So-So C: A lot 1- I can brush my teeth after breakfast.
2- I can brush my teeth after eating lunch.
3- I can brush my teeth after dinner.
4- I can brush my teeth after eating sweets.
5. I can brush properly and in the right way
Perceived behavioral control A: Yes B: So-So C: A lot 1- I can even if I do not have mood and patient, my toothbrush.
2- I can brush my teeth regularly while traveling.
3- I can brush regularly when I am sick.
4- If I run out of toothpaste, I can still brush regularly.
5- Even if I do not like the taste of my toothpaste, I can still brush regularly.
6- I can also brush my teeth at parties
Observational learning A: I agree B: I have no opinion C: I disagree 1- Because I see my family brushing their teeth, I also brush my teeth.
2- Because I see my friends brushing their teeth, I also brush.
3- Because I see children brushing their teeth in cartoons, I also brush my teeth Social support A: I agree B: I have no opinion C: I disagree 1- My parents guide me while brushing my teeth.
2- My parents supervise my brushing.
3- My parents help me with brushing.
4- My parents remind me when to brush my teeth.
Social reinforcement A: I agree B: I have no opinion C: I disagree 1- My parents always encourage me to brush my teeth.
2- My teacher encourages me to brush my teeth.
3- The school health instructor encourages me to brush my teeth.
4- My friends encourage me to brush my teeth Intention to behave A: Yes B: No 1- I decide to brush three times a day.
2. I decide to brush my teeth after breakfast.
3- I decide to brush my teeth after eating lunch.
4- I decide to brush my teeth before going to bed.
Behavioral preferences A: I agree B: I have no opinion C: I disagree 1- I like to brush my teeth in the bathroom.
2- I like to brush my teeth in the kitchen.
3- If my toothbrush is colorful and attractive, I would rather brush my teeth.
4- If I choose and buy my own toothbrush and toothpaste, I would rather brush my teeth.
5- I like to brush my teeth with my parents.
Checklist for controlling the correct brushing skills- Behavioral skills
Row Skills components Yes No
1 He washes his toothbrush and puts toothpaste the size of a pea on it.
2 Place the toothbrush at a 45-degree angle on the outer surfaces of the upper teeth and start brushing up and down from the last tooth.
3 Place the toothbrush at a 45 degree angle on the inner surfaces of the upper teeth and start brushing from the last tooth.
4 The masticatory surfaces brush the upper teeth in a longitudinal (reciprocating) motion.
5 Place the toothbrush at a 45-degree angle on the outer surfaces of the lower teeth and start brushing from the last tooth by moving it up and down.
6 Place the toothbrush at a 45-degree angle on the inner surfaces of the lower teeth and start brushing from the last tooth by moving it up and down.
7 The masticatory surfaces brush the lower teeth in a longitudinal (reciprocating) motion.
8 Brush each tooth at least 3 times using the above methods.
9 He brushes his tongue by moving backwards in front of the toothbrush 10 Observe the duration of brushing for 3 to 5 minutes.
11 You clean your toothbrush.
12 You clean your mouth.
Checklist - Evaluation of brushing behavior in the last week- Behavior
Friday Thursday
Wednesda y Tuesday
Monday Sunday
Saturday
Morning
Noon the night
